Good Hope, Heartlands, and Solihull Eye Clinics

Sore or dry eyes in brief

David Kinshuck Jan 2017

Introduction

Tears are made in a gland near the top of the eyeball, and spread over the front of the eyeball into tear ducts, and then down into the nose. 'Dry eyes' occur when there are not enough tears to keep your eyes lubricated, or the tears that are produced do not spread evenly across the eyes.

tear flow from lacrimal gland

Tears are normally made in the lacrimal gland, and flow over the surface of the eye. They run down tiny tear ducts into the nose. See animation.

 

dry eyes, side view 
Side view

dry eyes, front view

Front view

Dry eyes or poorly spreading tears: the surface of the cornea is covered with dry patches (like craters on the moon), and this makes the eyes very sore

Treatment

  1. diet
    • a healthy diet with fish and fresh vegetables (2 salads a day) and
    • pulses and grains,
    • minimal sugar and fat,
    • no processed food
  2. If you use the following drugs (or related drugs) ask your GP if the dose could be reduced: furosemide, bumetamide, omeprazole, lansoprazole, These drugs make the eyes dry/sore.
  3. Smoking makes the eyes much drier.
  4. Lid cleaning/hygiene may be needed…see Blepharitis
    • Blepharalean  wipes or
    • dilute Tea Tree Oil using a cotton bud to clean margin
  5. Lid compresses
    • hot compress (eg tissue soaked in hot water), or
    • Blephamask (see Altacor) or Meibopatch.  (Meibopatch available on prescription) heated masks may help, use for 5 minutes twice daily.
  6. Slightly dry:                Xailin gel 4 times day and Xailin night at night
  7. More severely dry :    Hyloforte or Hyabak or Thealoz duo every ½-2 hours, Clinitas (sodium hyaluronate 0.4% preservative-free) AND VitaPos at night
  8. This treatment takes about 4 weeks to work maximally
  9. See
    1. http://www.goodhopeeyeclinic.org.uk/sore%20dry%20eye.htm
    2. http://www.goodhopeeyeclinic.org.uk/blepharitis.htm
    3. http://www.goodhopeeyeclinic.org.uk/blepharitis.htm#lc     lid cleaning
  10. If this does not work consider
    1. If the eyes are red and inflamed, a short course of preservative free steroid drops such as dexamethasone preservative free twice daily for 3 weeks.
    2. (if that works, consider replacing with cyclosporine [Ikervis twice daily] for more long term use)
    3. If the eyes are still dry despite lots of lubricants, consider punctal plugs.
  11. Glaucoma drops for severely dry eyes or eyes with drop toxicity need to be preservative free, eg
    1. Monoprost nocte
    2. Cosopt preservative free (trusopt and timolol) twice daily

alternatively

    1. Dorzolamide  preservative free (trusopt) twice daily
    2. No timolol if asthma
  1. Score your dry eye..the Ocular Surface Disease Index here